Dermatomyositis

Algesia q8 (Acetaminophen 375mg + Tramadol 37.5mg)

Tramadol
General Classification: Centrally acting analgesic
Specific Classification: Opiod agonist
Mechanism of Action: Binds to mu-opioid receptors.
Inhibits reuptake of serotonin and norepinephrine in
the CNS.
Side Effects: Dizziness, headache, sleepiness,
constipation, nausea
Adverse Reactions: Seizures
Nursing Implication: Monitor pt. for seizures, taper
dosage to prevent withdrawal sx
Acetaminophen
General Classification: Antipyretic
Specific Classification: Prostaglandin inhibitor
Mechanism of Action: Inhibits the synthesis of
prostaglandins
Side Effects: Rashes, neutropenia, pancytopenia,
leukopenia
Adverse Reactions: Hepatotoxicity
Nursing Implication: Pt not to take more than
recommended daily dose, monitor for rash

Prednisone OD
General Classification: Corticosteroid
Specific Classification: Glucocorticoid receptor agonist
Mechanism of Action: Suppress inflammation and alter
of the normal immune response
Side Effects: Nausea, dec wound healing, petechial,
muscle wasting
Adverse Reactions: Peptic ulceration
Nursing Implication: Monitor for infection, adrenal
insufficiency (hypotension, wt. loss, NV), PO: with meals
avoid GI irritation

Prednisone is first-line therapy for dermatomyositis. It
slows the body's immune system and stop the
inflammatory attack on muscle, skin and other body
systems. These medicines control the inflammation,
ease pain, and increase muscle strength. It may
decrease inflammation by reversing increased capillary
permeability and suppressing polymorphonuclear
(PMN) leukocyte activity.

Methotrexate
General Classification: Immunosuppressant
Specific Classification: Antimetabolite
Mechanism of Action: Inhibition of DNA synthesis and
cell reproduction
Side Effects: Anorexia, hepatotoxicity, NV
Adverse Reactions: Pulmonary fibrosis, aplastic anemia
Nursing Implication: Monitor for symptoms of
pulmonary toxicity, may manifest early as a dry,
nonproductive cough, monitor for bleeding & infection

Methotrexate secondline meds or in combination with
prednisone that acts as steroid sparer. Frequently used
immunosuppressant azathioprine, methotrexate &
mycophenolate mofetil to slowly taper steroids.

Dermatomyositis is considered to be the result of a
humoral attack against the muscle capillaries and small
arterioles.
As the disease progresses, the capillaries are destroyed,
and the muscles undergo microinfarction. Perifascicular
atrophy occurs in the beginning; however, as the
disease advances, necrotic and degenerative fibers are
present throughout the muscle.

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